What to do when the insurance company does not pay for OSAGO. The insurance company does not pay for OSAGO: what to do What to do if the insurance company does not pay for OSAGO

What to do if the insurance company does not pay for OSAGO, underestimates the amount of compensation, delays the terms of payments, does not respond to claims and complaints; the procedure for pre-trial and judicial settlement of the conflict

The adoption of the law on compulsory third party liability insurance allows solving many problems that arise in connection with an accident on the road and the need to compensate for the damage caused to injured persons.

However, it is not uncommon for the insurance company not to pay for OSAGO at all or delay the payment terms for a long period of time. What can be done in this case, you will learn from the article.

When the insurance company does not pay for OSAGO

Each policy holder should be well versed in the nuances of "autocitizenship" and understand when the injured party is entitled to compensation, in what amount, for how long it is paid.

The law provides for a number of reasons why the insurer has the right to refuse to pay compensation.

You can familiarize yourself with them by studying carefully:

1. Civil Code of the Russian Federation,
2. Federal law on OSAGO,
3. OSAGO rules approved by the Bank of Russia.

According to these regulations, the insurance company does not pay for OSAGO if:

• there is no confirmation of the fact of an insured event or there is no way to determine the exact amount of damage (for example, if the damaged car was promptly repaired or disposed of);
• the person responsible for the accident did not have a valid policy at the time of the accident;
• the insurer did not receive an accident report from the policy holder;
• the injured person wants to receive compensation for lost profits, moral damage;
• the car was damaged during competitions, tests, training driving on a special site;
• the damage was caused by a special cargo transported by car (subject to the availability of compulsory transportation insurance);
• the culprit of causing damage is the insured himself, who provoked an accident or caused damage to his own car;
• the vehicle is damaged during loading;
• harm caused to persons in the performance of their duties will be compensated for by compulsory medical insurance or another policy;
• damage to passengers during transportation will be indemnified under another type of insurance;
• damage was caused to special types of property listed in Article 6 of the Federal Law on OSAGO (cultural monuments, antiques, etc.);
• damage to nature and the environment (for example, fuel spills);
• force majeure - unpredictable and uncontrollable circumstances (flood, war, etc.).

All of the above reasons are legal grounds for refusal; in other situations, the insurer is obliged to compensate for the damage.

When the insurance company delays payment

The rules provide for specific deadlines for the payment of compensation:

• 20 working days are given for consideration of a general case,
• 30 working days are given to resolve the issue of payment of compensation if the car was handed over for repair after the approval of the insurer.

Within the specified periods, the insurer must make a payment or issue a written refusal indicating the reason. The injured person has the right to appeal against the refusal in court.

When insurance pays little

There are also cases when the insurance company pays little for OSAGO. Motorists should remember about the limit on "autocitizen".

According to the current legislation, it is:

• 400,000 rubles - for property,
• 500,000 rubles - in case of death or harm to human health.

In cases where the amount of damage exceeds the established limit, the missing amount is recovered from the culprit.

The calculation of the loss is made either in accordance with the standards established by law, or according to the assessment of the insurer itself.

In the first case in the event of a death of a person, expenses for a funeral in the amount of 25 thousand rubles are reimbursed, and the remaining 475 thousand within the limit are paid to the relatives of the deceased.

Second option more flexible and allows insurers to underestimate the amount of compensation using various tricks (the connection of damage with a specific insured event is denied, individual details are not included in the list of damages, etc.).

The best way to avoid artificial understatement of damage is an independent examination, to which you can invite a representative of the insurer.

Litigation in court takes a lot of effort and time and is a last resort, which should be resorted to in exceptional cases. If the insurance company does not pay for OSAGO, first try to solve the problem in other ways.

Independent expertise

If you have any doubts about the honesty of the insurer and the accuracy of the calculation of the loss, please contact an independent expert. You can do it like this:

• Select a licensed company or individual specialist and conclude an agreement.
• Agree a time for an independent review.
• Notify the insurer of the time and place of the event. The best way is to send a telegram or registered letter with acknowledgment of receipt to obtain confirmation that the insurer was notified of the examination in advance.
• The examination may be carried out in the presence of the representative of the insurer or without him, if he did not appear at the specified time. This does not affect the result and the reliability of the procedure. The insurer present at the site can ask questions, follow the work of an independent expert.
• Send the expert opinion with photographs attached to it to the insurer along with your claim. Keep the second copy for yourself, it may come in handy in court.

Filing a claim

If you do not agree with the actions of the insurer and the amount of compensation for the loss, then you must first file a claim. In it, indicate the mistakes made by the insurer (underestimated amount of compensation, delay, illegal refusal to pay, etc.).

The law obliges insurers to resolve this issue within 10 working days. During this time, he is obliged to correct these errors or issue a written refusal, with which the insured can go to court.

Complaint to RSA

You can also complain to the PCA as a higher authority that is responsible for the actions of all Russian insurers. Write a complaint, attach all the documents and photos necessary to confirm your claim, send it all to the PCA.

If the essence of the issue is the amount of insurance compensation, then it is better for you to immediately go to court. PCA usually deals with gross violations of the law (for example, refusal to pay, the requirement to provide additional documents that are not provided for by the rules) and payments in the event of bankruptcy of the insurer.

Complaint to the Central Bank of the Russian Federation

You can complain about your insurer to the supervisory authority that controls the activities of all financial organizations - the Bank of Russia. However, the Central Bank of the Russian Federation also does not deal with conflicts, but only reacts to direct violations of the law.

Trial

If the insurance company refuses to pay under OSAGO or does not respond to a claim regarding an underestimated amount of compensation, filing a claim will be the best way to get your money. It is the court that is engaged in the recovery of fines for violation of laws, compensation for damages and compensation for non-pecuniary damage.

You can file a claim at any time if the insurer has not satisfied your claim or has not given a timely response to it. You need to do this as follows:

• Write a statement of claim, indicate in it the violations committed by the company, provide evidence that the insurer acted illegally.
• Pay the state duty.
• Make photocopies of documents confirming your correctness and the fact that the insurers violated the rules for considering the case: claims, the company’s response with a refusal to pay, the conclusion of an independent examination, a telegram about its conduct and other important evidence you have. Copies will be attached to the case, you will have to present the originals at the court session.
• Submit the claim, photocopies of documents and receipt of payment to the court. This can be done in person by contacting the court office, or sent by registered mail.

At the hearing, you must prove your innocence. You can use photos, videos, witness statements, documentation and any other arguments.

You have the right to ask the court for help if you are unable to obtain any evidence on your own. Then the judge will demand it officially in the department that can provide it.

After hearing the case, the court will make a decision in favor of one of the parties. If you are denied compensation, you can appeal the verdict to a higher court.

If, after sending a claim, the insurance company does not give its answer within 10 working days, you can write a complaint to the PCA or the Central Bank or immediately file a lawsuit in court.

The 10-day period is counted from the date of filing a claim:

• if you submitted it personally at the office of the company - from the date of admission,
• if sent by mail - from the day the letter was received by the addressee (the date and signature of the representative must be in the notification).

Non-pecuniary damage is compensated under the law "On Protection of Consumer Rights". However, if you believe that the refusal or late payment of compensation under OSAGO caused you additional psychological damage, then theoretically you can demand compensation in court.

You will have to provide convincing evidence that you have suffered from the insurer's unauthorized actions.

In fact, it is possible to achieve such compensation, but in most cases the court either refuses to compensate for non-pecuniary damage at all, or underestimates the required amount to a minimum.

Many motorists are interested in the question of whether the insurance pays the culprit of the accident under OSAGO. We remind you that OSAGO is insurance of civil liability to third parties, therefore all payments are made not to the person responsible for the accident, but to the persons affected by his actions.

Losses associated with damage to the car of the perpetrator of a traffic accident are covered by another type of car insurance - Casco.

Now you know the terms within which losses and claims are considered by insurers, where to complain if the company is suspected of dishonesty, how to achieve fair compensation for losses through the courts.

We hope that this will help you quickly and correctly resolve all issues with the insurer in the event of an accident and damage to your car.

How to make insurance pay?

When buying a car and for its further use, we are recommended to insure it without fail in order to receive some compensation in case of an accident. As soon as an insured event occurs, the insurance company is not always “happy” trying to pay the injured party the due compensation. Why doesn't the insurance company pay for OSAGO? How to force insurance organizations to fulfill their immediate obligations? You can find answers to this and other questions in this article.

If you find yourself in a situation related to the unwillingness of the insurance organization to fulfill its immediate obligations to pay the due compensation, both CASCO and OSAGO, then you should take special measures to help protect your interests and family budget. Most often, in such situations, insurance agents try to minimize the payments due to the client, or not to issue them at all. For most insurance companies and their clients, this is a familiar story.

Tip #1! If you are in a similar situation, you should not pointlessly demand the due payments from insurance agents, but seek help from a law office.

The help of a competent lawyer is most often able to force a negligent company to fulfill its immediate obligations. In our country, many law firms have been opened that provide consulting services of a lawyer free of charge, which is quite in demand among the population today. Especially if the client applied to this office for the first time. Based on this, we can conclude that only an experienced professional in the legal field is able to force the company to provide the required compensation to its citizens.

Contacting a legal organization will help you determine the legality of the actions of the insurance company and find the very grounds on which you can "pin it to the wall."

After the lawyer points out to the client some “levers”, by acting on which it is possible to force the insurance company to fulfill its debt, the injured party itself determines the strategy for its next actions. In many cases, clients completely transfer the entire case to the specialists of the law firm to resolve the conflict. Such behavior of the client is noticed if the insurance company does not pay for OSAGO either.

How to behave in case of non-payment of CASCO insurance?

When employees of the insurance company refuse to pay compensation to their client, according to the CASCO policy, it is necessary to demand a reasoned refusal in writing on paper. Such a paper will be a strong argument for litigation. Reasons for refusal by an insurance company to pay the due funds may be:

• unreasonable expertise;
• lack of important papers;
• doubts of insurance agents in the details of the insurance accident;
• refusal without explanation.

Such situations are the initiators of the necessary legal proceedings. When insurance agents require additional certificates or other papers from the client, there is some delay in the client's application to the court.

But it is worth taking into account the fact that there is a certain period of limitation. According to this period, all statements of claim and cases of violation of CASCO payments must be considered within the first two years, as soon as an insured event occurs. Based on this, we can conclude that if after six months from the moment of the insured event no payments were received from the insurance company, then most likely it is not worth waiting for them, but you should go to this organization yourself. It will be possible to force negligent employees to provide the required payments only through litigation.

And if the insurance does not pay for OSAGO, what to do? In the event that the insurer refuses to make the required compensation to the client under OSAGO, it is also necessary to take a written refusal from him on paper with an explanation of the reasons.

When the insurance company does not pay for OSAGO, the procedure should be as follows: a written refusal is taken and, on the basis of it, a statement of claim is written to the court. In this case, you can go to court if the due payments are not received within the first month from the date the necessary papers are received by the client.

Even when the insurance company refuses to pay for OSAGO, citing minor inaccuracies in paperwork, experienced lawyers will be able to force it to fulfill its obligations to citizens. Sometimes employees of insurance companies in cases of unreasonable non-payment of the due compensation can provide standard replies. In this situation, experienced lawyers immediately transfer the case for further consideration to the judicial authorities, thereby bringing the insurer to the due responsibility.

It is not uncommon for cases related to non-payment of the due compensation to the client for an insured event due to an existing legal basis. Such a case is the moment associated with the failure to establish the true culprit of the accident. For example, administrative proceedings may be closed due to sharp differences in the testimony of eyewitnesses with drivers. Such cases require immediate appeal to the courts for further proceedings.

Tip #2! When insuring a car for OSAGO, it is advisable to give it for additional inspection by employees of the insurance company. Such actions will save you from the emergence of unnecessary doubts on the part of the insurer in the event of a need to pay compensation or litigation.

To find out the truth of your situation if you do not receive compensation from the insurer, you can use a free legal consultation in any relevant organization. Such actions will help save your time, health, as well as money.

The insurance company underestimates the amount of payments. What actions to take?

In many cases, negligent insurers try in every possible way to cut the payments due to the insured event to customers. If the insurance company does not properly pay for OSAGO Casco, the procedure should be as follows: first you need to deal with the existing situation. The situation when the insurer cuts the due payments occurs when questions arise about the results of technical expertise. The insurer has the right to determine the place where the vehicle passes the technical examination. This means that with a decrease in the due compensation, one can refer to the received calculation of the experts of the insurance company, which consists of:

• cost of spare parts;
• evaluation of the work performed;
• percentage of wear of replaced auto parts;
• the general condition of the car and so on.

Of course, the employees of the insurance company carry out such calculations with their own benefit.
Many lawyers recommend that repairs be made to your car after an accident only when the insurer pays the due compensation. When receiving a much smaller amount from the expected compensation, it is worth involving a team of independent experts in evaluating the work. To conduct such an examination, you should invite the initiator of the accident on the road with his insurer.

It is within your rights to file a pre-trial written claim regarding the underestimation of the due compensation from the insurer. Such a statement will be a plus for you at the trial, since you can rely on it as a reason for submitting documents for further proceedings.

Filing an application to the court gives the victim the right to receive, in addition to the payments due to the insured event, also compensation for material damage in the form of an additional amount. If you manage to win this case, the insurer will have to carry out the increased OSAGO payment due to you. A plus to this is the payment of all legal costs, as well as payment for the examination.

Upon receipt of a small payment under OSAGO, you are given the full right to recover the due interest from an unscrupulous insurer. This provision is enshrined in paragraph 1 of Article 395 of the Civil Code of the Russian Federation.

The car owner should focus on the fact that such situations often end with the client's independent appeal to the court. A special representative is supposed to protect your interests at such a meeting. It is extremely difficult to “bring the insurer to clean water” on your own without the help of an experienced lawyer. Therefore, in such situations, it is best to entrust your case to an experienced lawyer who knows all the legal intricacies and will easily sue the payments due to you.

Documents required for filing a lawsuit against an insurance company

In order to file a claim for non-payment of the due compensation from the insurance company to the court, it is necessary to collect the following package of papers.

1. A copy of all papers that confirm the existence of an insured event. This includes the relevant resolutions, protocols, certificates, papers from the traffic police or a notice filled out by two parties to the accident.
2. A copy of the paper that confirms the submitted claim for damages to the insurer.
3. A reporting form confirming an independent examination on determining the cost of damage caused to a car due to an accident.
4. Claim Form.
5. Copies with original receipts and checks that confirm the paid expense.

Of course, if the driver after the accident repaired his car himself for his own money during the first month, hoping to subsequently receive the due payments from the insurer, then it is likely that he will not receive them. Such an independent restoration of the vehicle deprives the car owner of the chance to conduct an independent expert assessment of the damage caused to the car in the event that the insurer does not pay the due amount to the client within the first month.

Payments may not be made by the insurance company if it is impossible to carry out an examination of the damaged car by independent expert organizations due to the fact that it has already been repaired and brought to perfect condition. Therefore, it is practically impossible to calculate the damage received by the client in this case.

Such a case provides only for the provision of an order from the service center, where auto repair work was provided. One has only to take into account that the documents provided by such organizations are not always taken into account by insurers for making OSAGO payments.

The reason for such non-acceptance of papers by the insurance organization is the action of the methodological manual that determines the true cost of standard hours for a motor vehicle. In this case, the natural wear and tear of the machine with its general technical condition by the time it is presented for examination is taken into account. Experienced lawyers and lawyers recommend that if you get into an accident, do not take on car repairs on your own, but wait for the due payments from the insurer.

When a car owner, valuing his own time, undertakes to repair a car without payments received from the insurer, you should contact independent experts before starting restoration work and conduct an examination with them at your own expense. After that, the car owner should wait for the results of the examination in the form of a report and only then send the vehicle for repair.

What to do if the insurance company refuses to pay for OSAGO?

To get acquainted with the procedure for the unwillingness of the insurance company to pay the required compensation upon the occurrence of an insured event, you should watch this video.

The insurance company does not pay or delays payment? No time and desire to spend time searching for the truth? If these questions are relevant to you, please contact the "ACCIDENT HELP". Our lawyers will understand the situation and help you get the due compensation from the insurance company.

Call! Our services are paid by the insurance!

We work without prepayment!

Why the insurance company does not pay for OSAGO

The most popular reasons for refusal of payment today are the following:
1. Not enough documents.

As practice shows, this problem is often faced by people who apply for OSAGO payments for the first time. The insurer may require an impressive package of documents - up to 15 items. If not all documents are prepared and provided, then the insurance company may refuse to pay.

2. The presence of errors in filling out the documentation.

Even a small and insignificant error in the documents can lead to a denial of payment. This problem is faced not only by amateurs, but also by experienced drivers who have already dealt with insurance companies. So that the deadlines are not delayed, it would be better to contact an experienced auto lawyer who will help with filling out all forms, forms and documents.

3. Deliberately ignoring the requests of the victim.

In this case, everything is simple and clear. Deliberately ignoring appeals suggests that the insurance company does not want to part with the money and pursues its own benefit. In such a situation, it is necessary to prepare a claim, and if it is not satisfied, prepare for court.

What to do if the insurance company refuses to pay out under OSAGO?

A difficult option is to independently collect documents, prepare a claim, a statement of claim in court, etc. It is possible, but you need relevant knowledge of regulations, experience and free time.

The ideal option is to seek help from independent experts. Conducting will determine the legitimacy of the refusal. It is also necessary to draw up a conclusion, which will be weighty evidence in court.

5/5 (5)

What to do if the insurer does not respond to the application

If, after 20 days from the date of receipt by the insurer of the application for compensation for damage, the insured has not received a call to inspect the car or transfer funds, then it is necessary to act in accordance with the following algorithm.

Independent damage assessment

First of all, you should contact an independent specialist who will inspect your damaged car and draw up an opinion on the cost of its restoration repair.

You will have to pay for the services of an expert yourself.

The result of the examination will be a specific amount to be transferred to the victim from the insurance company.

If, in addition to damage to property, damage to health has been caused, then it is also necessary to contact a medical organization to obtain a conclusion on the state of health.

Refusal to pay

The law clearly indicates the list of cases in the presence of which the insurer has the right to refuse a person in the implementation of compensation for material damage.

Some of these legal acts include:

• Civil Code of the Russian Federation;
• Federal Law "On Compulsory Insurance of Civil Liability of Vehicle Owners";
• the rules for compulsory insurance of civil liability of vehicle owners, approved by the regulation of the Bank of Russia dated September 19, 2014 No. 431-P (hereinafter referred to as the OSAGO Rules).

On the basis of the above acts, the insurer has the right to refuse compensation for damage in the following cases:

• the insurer doubts that the accident actually took place, or it is impossible to determine the damage to be compensated. For example, this is possible when the victim repaired his damaged vehicle before the inspection of the IC;
• the perpetrator of the accident did not insure his civil liability in the prescribed manner;
• The accident occurred during the period when the existing OSAGO policy was invalid;
• the owner of the vehicle did not provide all the information about the accident to the insurer;
• The accident occurred in the course of training driving, auto racing, as well as in the case of testing new vehicle designs in the event that the competition or test was held in a place specially designated for this;
• the driver of the vehicle was found guilty of an accident;
• the damage to the vehicle was caused at the time of loading the vehicle;
• as a result of an accident, harm was caused to life or health of persons who are passengers, provided that such harm is compensated on the basis of the standards applicable in the case of compulsory life and health insurance in the course of passenger transportation;
• as a result of an accident, damage was caused to cultural monuments and other items that are recognized by civil law as especially valuable;
• The result of an accident is environmental pollution.

The above list of cases is exhaustive. This means that refusal to pay in the presence of other circumstances is not allowed.

Violation of the payment deadline

In addition to the unreasonable refusal to pay material compensation, another violation of the law by insurance companies is the violation of the terms for the payment of monetary compensation.

Important! According to the OSAGO legislation, the following lists of terms are provided:

• 20 days from the date of receipt of the application for inspection of the vehicle and transfer of funds;
• 30 days, when the victim, as agreed, began repair work that is carried out at the service station.

This period includes calendar days, excluding holidays, which are officially established by labor legislation.

During this period, the insurance company transfers funds to the victim or sends a written reasoned refusal about the reasons for non-payment of funds. The refusal can be appealed in court.

Watch the video. What to do if the insurance does not pay for OSAGO:

Didn't pay enough

In addition to a complete refusal to pay material compensation, which is necessary for a damaged car, insurance companies underestimate the amount of payment to the victim.

Attention! Therefore, the victim should be aware of the maximum amounts to be paid. So, in accordance with Art. 7 of the Federal Law "On OSAGO" the insurance company is obliged to pay cash in the following amounts:

• 400,000 rubles in case of property damage;
• 500,000 rubles in the case when the damage is caused to the health or life of a person.

When the damage exceeds the specified amounts, the victim has the right to apply directly to the culprit with a claim for the recovery of unreceived funds.

Compensatory funds that are subject to compensation to the victim are determined by the insurer in the following ways:

• in accordance with the standards established by law. For example, when a person died as a result of an accident, the insurance company reimburses relatives 475,000 rubles and expenses associated with the funeral - 25,000 rubles;
• based on the results of the examination conducted by the insurance company.

As a rule, it is in the latter case that problems most often arise: the insurance company, realizing that damage is a rather subjective category, tries in every possible way to reduce the amount of funds that are paid to the victims.

In this case, the technique of unnoticed damages that are detected on the vehicle is used, and the IC tries to challenge the results of an independent examination.

Claim to the insurer

After receiving the results of the examination in the form of a conclusion, it is necessary to draw up a pre-trial claim to the insurance company. In this claim, information about the participants in the accident, the place of the accident, the civil liability insurance of each of the participants, as well as the amount of damage, which is established by the conclusion, must be indicated.

In accordance with the law, the claim after its receipt by the insurer is considered within 10 days.

The claim should be sent by mail with a valuable letter with an inventory. The shipping receipt should be kept.

Handing the claim in person is allowed. In this case, you should ask the authorized employee to date and sign the second copy of the claim.

ATTENTION! View the completed sample pre-trial claim to the insurance company:

Attention! Our qualified lawyers will assist you free of charge and around the clock on any issues.

Complaint to the RSA or the Central Bank of the Russian Federation

Since going to court involves waiting for a long period of time, lawyers recommend first trying to resolve a legal dispute out of court.

A complainant may file a complaint with the following authorities:

• RSA (Russian Union of Motor Insurers). This authority receives complaints from policyholders, and also assists in resolving disputes with insurers;

To apply, you must fill out an application, the form of which is standard for each of the listed bodies.

A list of documentary information received from the insurer should be attached to the application.

ATTENTION! View the completed sample application in the PCA:

Procedure through the court

One of the ways to protect your right is to file a claim with a judicial authority.

The limitation period, during which the victim has the right to exercise the right to judicial protection, is 3 years from the date of the accident.

To file a claim, you must prepare:

• documents confirming the fact of an accident (accident notice, decisions issued by the traffic police);
• information received from the insurance company (responses to an application or claim).

Please note that the state fee for this category of cases is not charged to the plaintiff. The magistrate's court should be applied in the event that the amount of the claim is less than 50,000 rubles. In other cases, the statement of claim is submitted either to the district or to the city court, depending on where the plaintiff lives.

Claim Form

The claim must be in writing. You can send it by letter or submit it personally through the office of the judicial authority.

In the process of drawing up a claim, a person must indicate exactly the information about the accident, about the participants in the road accident, information about insurance companies, as well as the amount of damage and the claim of the plaintiff.

In addition to the requirements and facts about the accident, it is advisable for the plaintiff to refer to the regulatory framework that was violated by the insured.

Attention! The following list of documents must be attached to the statement of claim:

• a copy of the statement of claim in accordance with the number of persons involved in the process;
• documents about the accident;
• application and claim to the insurance company;
• examination results.

ATTENTION! View the completed sample claim for the recovery of insurance compensation:

Reasons (reasons) for non-payment - in what cases (legal and illegal) does the insurance company not pay insurance?

So, let's first consider the possible pretexts for refusing OSAGO. In fact, these prepositions are few. First, let's figure out what OSAGO is. This is primarily a car owner's liability insurance.

Thus, you need to understand that when purchasing an OSAGO policy, you do not insure the car against damage, but your civil liability to third parties.

Simply put, this means that if you damage someone else's property (this can be not only a car, but also, for example, a bicycle, a lamppost, a fence, and so on), the insurance company will pay the damage to the owner of this property for you (in within the sum insured).

If you are innocent, your policy will not be activated at all, and the premium will be made according to the policy of the culprit.

Grounds for the release of the insurer from the payment of OSAGO

• the insurance of the culprit was not valid on the date of the accident;
• the culprit insured a car other than the one involved in the accident;
• the victim restored his property before fixing the damage by an independent expert organization;
• The accident occurred during the use of the insured car by the perpetrator in competitions, trials or for learning to drive on sites prepared for this.

These grounds are legitimate and quite logical. In addition, according to Art. 6 of the OSAGO Law, the insurer will refuse to pay for:

• unearned income that the victim would have received under normal circumstances;
• moral injury;
• pollution of the environment;
• antiques, precious metals, cultural heritage, etc.;
• damage caused by the transported cargo (if the risk of transportation had to be insured separately);
• harm received by passengers or employees (if such harm must be paid for under the relevant type of insurance);
• damage incurred while loading or unloading a vehicle.

The insurance company cannot have other legal grounds for exemption from payment. It must be understood that in no case are the reasons for refusal, such circumstances as:

• the culprit was not included in the OSAGO policy;
• was under the influence of alcohol;
• left the scene of the accident.

None of the above grounds exempts the insurer from making a payment.

The insurance company does not pay for CASCO: what to do? Here the situation is a little more complicated for the simple reason that a voluntary type of insurance, the terms of which, unlike OSAGO, are not regulated by the State. Insurers themselves draw up insurance rules and they are different in each company, which means that there can be a great many reasons for refusal.

If the insurance company does not pay for CASCO, the procedure should begin by considering the main reasons for a possible refusal. CASCO is a voluntary property insurance, in particular a car. The standard contract contains the following risks:

• damage to the vehicle (in the event of a traffic accident, unlawful actions of third parties, fire, exposure to natural phenomena or animals);
• theft of the vehicle (in other words, theft);
• complete or constructive loss of the vehicle (such damage to the car, after which restoration is not advisable).

The vast majority of insurance companies will refuse to pay out under the following circumstances:

• the event occurred at a time when the policy was not in effect (has not yet begun or has already ended);
• driving a person under the influence of alcohol or drugs, who did not have the right to drive a vehicle under the terms of the CASCO agreement, or a person who does not have (deprived) of a driver's license;
• the damage was caused by the malicious intent of the owner himself;
• damage was caused by exposure to radiation, a nuclear explosion, military operations, or during the seizure of a car by state authorities;
• the circumstances under which the car is damaged are unknown (in this case, the insurer simply cannot establish the existence of an insured event);
• damage was received when loading or unloading a vehicle or when renting it, lysing without agreement with the insurer;
• the insurance company will refuse to repair damage caused to uninsured additional equipment (for example, you insured a car with summer wheels, and the damage was caused by winter ones);
• damage to parts that were required to be repaired before insurance is not covered (for example, if you insure a car with a dent in the fender, the insurance company will not pay for the repair of this fender in the future);
• car theft along with registration documents, ignition keys.

Depending on the conditions of insurance, there may be other reasons for refusal to pay insurance compensation.

How long does it take for an insurance company to pay out money for hull and motor vehicle insurance?

Often, insurance companies delay the processing of applications for payment of insurance compensation. How to determine the period in which the insurer must make a payment?

In terms of OSAGO, this period is clearly regulated by the Law- no more than 20 days, excluding official holidays, from the date of submission of the last document and inspection of the car by an independent expert organization.

Terms for voluntary insurance are established by the insurance rules and, as a rule, do not exceed two weeks. Thinking about which insurance companies pay out in cash, do not doubt that the ones we are considering in this article can and should do this. But what to do if the insurance company does not pay money on time, we'll talk further.

Insurance does not pay: procedure

In the event of a refusal of an insurance payment, you need to calmly, putting aside emotions, study it for legality. If, from your point of view, the refusal is not legal, then for a start it is worth contacting the insurance company for negotiations.

To reinforce your intention, it is necessary to indicate the number of the insurance policy, the circumstances of the event and the reasons for your disagreement with the refusal. The claim must be prepared in two copies: one copy is transferred to the insurance company, the second remains with you.

Important get confirmation from the insurer of the receipt of the document, this can be done by asking you to put an incoming number and seal on your copy. In case of refusal to accept the claim, you can send the document by valuable letter with notification.

Obtaining confirmation of an attempt to pre-trial settlement, an important point if in the future you intend to go to court to protect your interests (see)

Indeed, for OSAGO, for example, the Law establishes no alternative and if you cannot prove to the court that you applied to the insurer with a claim, the judge will leave your case without consideration.

What should I do if the insurance company refuses to pay again? There is another option for pre-trial settlement - a complaint against the decision of the insurer to the insurance supervisory authorities.

In the case of OSAGO, it is necessary to file a complaint with the Russian Union of Motor Insurers and the Central Bank of the Russian Federation, in the case of CASCO - only with the Central Bank of the Russian Federation, since the PCA only deals with issues of motor vehicle citizenship.

The supervisory authority will request the necessary documents and explanations from the insurance company. In case of detection of violations of the current legislation or insurance rules, the regulator will oblige the insurer to reconsider its decision to refuse.

If you still cannot resolve the dispute peacefully, and you are sure that you are right, you should definitely go to court to protect your interests.

The first step will be the preparation of the necessary documents, the list of which is as follows:

• statement of claim;
• receipt of payment of state duty;
• a copy of the insurance contract and a receipt confirming its payment;
• copies of documents submitted to the insurance company during the initial application;
• a copy of the letter of refusal to pay;
• a copy of the pre-trial claim and its response;
• a copy of documents confirming the ownership of the damaged car and a civil passport;
• a copy of the representative's power of attorney.

It is worth dwelling in detail on the content of the statement of claim. It must indicate:

• the name of the judicial body;
• name of the plaintiff (full name, residential address, contact phone number);
• name of the defendant (name of the insurance company, location address);
• the circumstances of the case;
• claims (amount of damage, penalty, legal costs, etc.).

For information on how to file a claim against an insurance company under CASCO, read the article.

The above set of documents is prepared in duplicate, one of which is sent to the respondent. Where to go with this?

So, now with a prepared claim, you need to go to court at the location of the defendant - the insurance company. Within 5 days, the court will consider the submitted documents and, if the package was prepared correctly, will make a decision on accepting the statement of claim for proceedings. After that, it remains only to wait for the appointment of the date of the trial.

If you received a refusal to pay insurance compensation from Rosgosstrakh

Rosgosstrakh is one of the largest insurance companies in Russia, a huge number of concluded contracts and the presence of sales offices in all regions of the country encourage the insurer to refuse to pay out for sometimes far-fetched reasons.

Being virtually a monopolist in the insurance market in many remote corners of the country, the company is not afraid of losing a client.

When drawing up documents about an accident for Rosgosstrakh, be extremely careful, because on this basis, the insurer refuses very often, for example:

• incompletely filled European protocol if the registration of an accident occurs without the participation of police officers. Fill in all the available fields, do not forget to indicate that 2 cars were involved in the accident, and property or people's health was not affected. Be sure to draw a diagram of the incident and describe all visible damage to the cars, after which, together with the second participant, put your signatures on the front side of the document. Further, each participant in the accident must fill out the reverse side of the notice, describing the circumstances of the accident there, the culprit admits his guilt in writing.
• errors in traffic police documents. Check the certificate issued to you immediately at the scene of the accident. Rosgosstrakh will find fault with the document if it finds errors in the full name. drivers, the name of the car or its state and identification (VIN) number. In addition, the certificate must indicate the degree of guilt of both participants and the clause of the traffic rules violated by the culprit.
• incomplete set of documents. The list of mandatory documents is enshrined in clause 3.10 of the OSAGO Rules. In the event that only the car is damaged, this list includes:
  • the identity card of the recipient of the payment;
  • a power of attorney to receive funds (if the reimbursement is not received by the owner of the car);
  • bank details for transferring the insurance payment;
  • certificate of an accident (form No. 154);
  • notice of an accident;
  • copies of the protocol, resolution, definition, if any of these documents was compiled by traffic police officers.

    You can clarify this in the accident certificate - if there is a checkmark next to the name of the document, it means that the document was drawn up and is required to be submitted to the insurance company.

Do not start repairing your car until it has been inspected by a Rosgosstrakh representative or an independent expert on behalf of the insurer. Also, before the inspection, you should not change the picture of the consequences of the incident (remove the bumper, correct the fender so that it does not rub against the wheel). Both of these actions will result in a denial of insurance payment.

Another typical reason for refusal to pay from Rosgosstrakh- non-contact accident. An example of such an accident is as follows: avoiding a collision with another vehicle, the driver makes a maneuver and crashes, for example, into a tree.

In this case, two cars will be involved in the accident, but only the car of the victim will receive damage. Under such circumstances, Rosgosstrakh, unfortunately, will almost completely refuse the insurance payment.

If you have received a refusal to pay insurance compensation from Rosgosstrakh, do not worry and, first of all, carefully read the reason for the refusal, and if it does not comply with the law, feel free to defend your rights, and the above instructions will help you with this.

Conclusion

As experience shows, not always the refusal of insurance payment is legitimate. By refusing to pay out, the insurer is often sure that a legally unsophisticated consumer will not argue.

At the same time, it is simply necessary to defend your rights! Realizing that the policyholder is serious, many insurance companies will prefer not to bring the case to court, but to fulfill their obligations on a voluntary basis.